Courtesy of American Medical Systems EXPLORING THE Penile Prosthesis Procedure by Debbie Gutierrez, CST

nsertion of a penile implant is often performed in men with erectile dysfunction. This Isurgery is performed when prescribed medications or penis pumps do not work for the patient.1 There are different types of implants used for this type of surgery. The two most popular types of implants are the inflatable implant and the semi-rigid implant. This procedure usually takes one to two hours and the patient usually is discharged the same day as the surgery.8 In this particular case study, the patient is a 60-year-old male who was scheduled to have outpatient surgery for the insertion of a semi-rigid prosthesis or implant. The patient’s height was six feet, three inches and weighed 180 pounds. The patient’s vital signs were taken preoperatively by the nurse: his blood pressure was 120/71; his heart rate was 83 beats per minute; his respirations were 18 breaths per minute; his oxygen saturation was at 96%; and his temperature was 36 degrees Celsius. His total Braden score was 23. The patient’s NPO status also was checked prior to surgery. He was NPO for 12 hours upon his arrival to the hospital.11

PATHOPHYSIOLOGY LEARNING OBJECTIVES The patient was diagnosed witha malfunctioning penile implant. The patient had an inflatable implant inserted three years prior to ▲ Learn about the procedure for the this surgery.11 The implant malfunctioned because the balloon or implantation of a penile prosthesis reservoir was leaking fluid. ▲ Compare the pros and cons of the The inflatable prosthesis has two silicone rods that are surgi- different types of penile implants cally placed inside both sides of the corpus cavernosum of the penis.9 A pump and a reservoir are attached together with tubes. ▲ Identify the equipment needed to The balloon or reservoir is filled with liquid and is placed under- insert a penile prosthesis neath the sartorius muscle and the adductor magnus muscle, ▲ Examine the complications that can the muscles of the groin. The pump lies in the scrotum and is occur with a penile implant attached with tubing to the reservoir and the silicone rods that are placed in the penis. The implant inflates and the liquid is dis- ▲ Access the relevant anatomy and placed or transported to the silicone rods in the corpus caverno- physiology associated with this sum of the penis. The water transports to and from the reservoir procedure

OCTOBER 2011 | The Surgical Technologist | 447 tile dysfunction. The nerves of the penis could be damaged by a pelvic surgery. A prostatectomy is an example of a pelvic surgery that can lead to erectile dysfunc- tion. “Erectile dysfunction is essentially a vascular disease.”1 Some other causes of ED include diabetes mellitus and cardio- vascular disease. Males that suffer from type 2 diabetes have a higher risk of ED, and advancing age increases the risk by more than 15 percent. “It is been estimated that about 35-75% of men with diabetes will experi- ence at least some degree of erectile dys- function during their lifetime.”13 The nerves in the penis and the small blood vessels that supply the penis become damaged due to diabetes mellitus. The hormones produced in males may still allow them to feel like they can achieve an erection, but they physically are unable to.13 Cardiovascular disease also is associ- The 700 PS Approach 1-Piece Penile Prosthesis ated with erectile dysfunction. In males, COURTESY OF AMERICAN MEDICAL SYSTEMS smaller blood vessels in the extremities and the penis are the first parts in the body that have poor circulation due to and the pump. This action inflates and deflates the penis.14 vessel damage. “Studies estimate vascular diseases may be The fluid leak can occur in any part of the prosthesis. responsible for causing erectile dysfunction in as many as This type of complication can occur immediately following 50 to 70 percent of men who develop the condition.” Erec- surgery. This is due to improper implantation of the pros- tile dysfunction can be a sign of heart disease since it is thesis or a defect in the product. This requires the implant usually caught first; if males are experiencing erectile dys- to be replaced by a surgeon.2 Improper implantation is only function they should seek medical attention to check for one of the problems that can occur with a penile implant. any problems with cardiovascular disease.12 Other complications can include tubing kinks, aneurysm, lack of dilation of the cylinders, breakage of the wire, sili- DIAGNOSTIC TESTING cone spillage, loss of rigidity to the prosthesis, erosion of A patient history and physical is taken for every patient. For the reservoir, spontaneous deflation, spontaneous inflation, this patient, the physician conducted an H&P and a physi- penile curvature or pump or pump reservoir migration. cal examination. The doctor then inflated the prosthesis to Most male patients receive penile implants in order to treat make a diagnosis. An X-ray also was taken. Radiographic erectile dysfunction. Medications also can help with ED studies are done to find any malfunctions in the penile and surgery is considered a last resort. Erectile dysfunction implant. A contrast medium is used to fill the inflatable occurs more frequently in the United States because the life implant. This allows the doctor to see how the implant is expectancy is rising. It mostly affects males that are 65 and situated and to see if any fluid is leaking from it. The phy- older.1 “Approximately 25 million American men and their sician will take an X-ray of the implant while it is inflated partners are affected by erectile dysfunction, the inability and then again when it is deflated, allowing the physician to to achieve an erection.”3 There are different causes of erec- analyze the entire prosthesis system.2

448 | The Surgical Technologist | OCTOBER 2011 RELEVANT ANATOMY AND PHYSIOLOGY exterior via a slit-like opening, the external urethral orifice The penis, the male reproductive organ, is composed of or meatus.”5 spongy tissue and is separated into three parts. The parts are The penis’ blood supply comes from the dorsal artery called the corpus. “The cavernous structures of the penis, and the central artery. The two central arteries run through the two corpora cavernosa are positioned on the dorsal side the corpora cavernosa and the dorsal arteries are located on of the penis and lie side by side.5 The third corpus is called the dorsal side of the penis. The veins of the penis are called the corpus spongiosum. The corpus spongiosum is smaller the dorsal veins and the external pudendal veins. The dorsal and houses the urethra. The corpus spongiosum eventu- veins are located next to the dorsal arteries and the puden- ally forms the glans penis; this is the distal portion of the dal veins are located at the base of the penis. The dorsal penis. The corpora cavernosa are surrounded by connective nerve also runs on the dorsal side of the penis. tissue; this attaches the corpus spongiosum to the corpora The process of an erection occurs because of the auto- cavernosa. The foreskin, also called the prepuce, starts at nomic nervous system and the arteries and veins of the the base of the penis and extends over the glans penis. The penis. “Sexual arousal stimulates parasympathetic nerves foreskin is not thick and does not contain hair.5 The foreskin in the penis to release a compound called nitric oxide, can be removed by a circumcision, but it is not necessary.3 which activates the vascular smooth muscle enzyme gua- The head of the penis is called the corona. “The urethra nylyl cyclase.”3 This causes the rise in blood flow into the passes through the corpus spongiosum and opens to the penis. The blood enters the corpora cavernosa and creates

COMPARING IMPLANT TYPES The decision about which type of implant is based on a patient’s preference and his medical situation. Factors including age, risk of infection, and health conditions, injuries or medical treatments should be considered before a penile prosthesis surgery.13

TYPE OF IMPLANT PROS CONS Three-piece • Creates a more natural erection than a semirigid • Has more parts that could malfunction than any inflatable implant other implant • Creates a firmer erection than a two-piece implant • Requires the most extensive surgery of any implant • Takes pressure off the inside of the penis when • Requires a reservoir inside the abdomen deflated, reducing the chance for injury Two-piece • Requires a less complicated surgery than the three- • Requires more extensive surgery than does a semi- inflatable piece implant rigid implant • Creates a more natural erection than a semirigid • Is mechanically more complicated than a semirigid implant implant • Takes pressure off the inside of the penis when • Results in a bulkier scrotum than a three-piece deflated, reducing the chance for injury implant • Provides less firm erections than a three-piece implant Semirigid • Requires the least extensive surgery of all implant • Results in a penis that is always slightly rigid types • Is more difficult to conceal under clothing than • Has fewer parts than any other implant, so less other devices chance of malfunction • Puts constant pressure on the inside of the penis, which can cause injury in some men

OCTOBER 2011 | The Surgical Technologist | 449 Lonestar Retractor, the Dura Hooks to the Lonestar Retrac- The decision about which type of implant tor, Heagar Dilators, the surgeons gloves, suture, #15 blade, is based on a patient’s preference and his bulb syringe, extra Mayo stand cover, Foley catheter tray and instrument sets. medical situation. Factors including age, BACK TABLE SET-UP risk of infection, and health conditions, Aft er the supplies were opened, the surgical technologist scrubbed in and began organizing the back table with all injuries or medical treatments should be of the opened supplies. For this procedure, four blue tow- els were laid out; two vertically at the end of the table and considered before a penile prosthesis two horizontally in the middle of the table. Th is allowed surgery. for more durable protection of the sterile fi eld. Two Mayo stands were brought into the room prior to set up. Th e sur- gical technologist placed the Mayo stand covers over the Mayo stands. Two blue towels were set out on each of the an erection. Mayo stands and tucked in. A blue drape sheet was placed The external genitalia of the male are the penis and over one Mayo stand in order to prevent lint from getting the scrotum. Th e scrotum contains the testes. Th e tunica on the instruments from the blue towels. The basin was albuginea surrounds each testicle. Th e tunica albuginea is moved to the corner of the table and the sharps box, kidney made up of connective tissue. Th e tunica vaginalis covers basin, small basin and medicine cups were organized on the the tunica albuginea and the spermatic cord. Th e nerves, table. Th e surgical technologist checked the indicators on testicular artery, and testicular vein insert into the testes the instrument sets one at a time. Th e drapes were stacked on the posterior side; the tunica vaginalis does not cover on the left side of the table and placed in the order that they this part of the testicle. Each testicle contains seminifer- would be draped on the patient. An extra basin was opened ous tubules. “A large number of convoluted seminiferous on a single ring stand. tubules lie between the septa of the testis. Th ere are approxi- Once everything was organized, the surgical technolo- mately 800 of these tubules.”5 Th e seminiferous tubules help gist called the circulator over to start the initial count. in the production of spermatozoa. Th e tubules eventually Both the circulator and the surgical technologist counted leave each testicle and enter into the epididymis.3 Th e epi- the sharps, sponges, suction tip and scratcher. Th e sharps didymis receives blood from the vessels that branch off of counted were the suture needles, tip for the electrosurgi- the testicular artery. cal pencil, knife blades and the Dura Hooks from the Lon- Th e sperm runs through the vas deferens aft er the epi- estar Retractor. Th e circulator wrote down the count on the didymis. Th ese eventually form into the seminal vesicle and white board and a sheet of paper. Th e instruments were not the ejaculatory duct. Th e urethra is connected to the ejacu- counted during the initial count because the abdominal latory ducts and the sperm is emptied into the urethra. cavity would not be entered during this procedure. Once the count was complete, the surgical technologist asked the SURGICAL INTERVENTION circulator for all of the medications, irrigation, sterile water The room set up for this specific insertion of a penile and alcohol to be poured onto the sterile fi eld. Each solu- implant consisted of a normal set up. The operating table tion was poured one at a time and the surgical technologist was placed in the center of the room and the anesthesi- labeled each basin or medicine cup with the correct name ologist cart was placed at the head of the operating table, and percentage. above the patient’s head. The surgical technologist opened the pack on the back table and began the sterile set up. The MAYO STAND SET-UP surgical team consisted of a surgeon, a surgical first assis- Aft er the initial count, the fi rst Mayo stand was set up. Th e tant and a surgical technologist. The sterile set up began surgical technologist removed two Army-Navy retractors, approximately 20 to 30 minutes prior to the patient’s arrival. two Mayo clamps, six Allis clamps, two DeBakey forceps, Some of the supplies opened onto the back table included a curved Mayo scissors, straight Mayo scissors and the Met-

450 | The Surgical Technologist | OCTOBER 2011 zenbaum scissors from the instrument set and organized them on the Mayo stand. Two Raytec sponges and the #15 knife blade were placed on the Mayo stand. The Mayo-Hegar needle holder was used to load two 2-0 Vicryl CT-1 sutures, one dyed and one un-dyed, and placed them on the Mayo stand. The second Mayo stand was for the penile implant as well as a right angle clamp, Iris scissors and a retractor. A small basin was filled with irrigation, a mix of saline and polypeptide antibi- otic, would help get rid of bacteria in the wound when irrigating it.

PREPARATION OF THE PATIENT Once the surgical technologist set up the preoperative sterile field, the patient was ready to be brought into the operating room by the nurse. The nurse introduced the patient to everyone in the room and asked him to state the name of the sur- gery he was receiving and the site of the The 700 Series 3-Piece Inflatable Penile Prosthesis surgery. The gurney was then locked and COURTESY OF AMERICAN MEDICAL SYSTEMS parked next to the operating table. The patient was transferred from the gurney to the table and positioned by the staff. The anesthesiolo- SKIN PREP AND PREP SOLUTION gist gave the patient some oxygen and began to intubate Before the skin prep was initiated, the circulator had to him. After the patient was positioned, the nurse began the shave the patient. The patient’s hair on the scrotum and part patient skin prep. of the shaft of the penis was removed with clippers. This was done for the peno-scrotal incision.10 Once the shave was fin- POSITION AND POSITIONING AIDS ished, the circulator began the skin prep. A povidone-iodine The patient was placed in the supine position. His arms were scrub and solution was used for the prep.11 A drape was extended out on padded arm boards at a 90-degree angle placed in order to cover the anus of the patient to prevent bilaterally and restrained with safety straps.11 The patient’s infection. The entire perineal area was prepped. The scro- legs were separated in order to allow access to the penis and tum and penis were prepped first, starting at the incision scrotum. All boney prominences, including the elbows and site. The prep extended up to the patient’s umbilicus and the heels of the foot were padded with egg crates. Padding down to the patient’s mid thighs. The prep extended later- also was placed under the patient’s head for head support. A ally down to the operating table on both sides. blanket was placed over the patient’s arms to prevent hypo- thermia. The patient was an older male so the surgical team DRAPING was aware of any places on the patient’s body that would be The surgical technologist began the draping process along prone to pressure injuries. “These areas include the occiput, with the surgeon. The surgeon placed one folded blue towel scapula, olecranon, sacrum, ischial tuberosity and calcane- under the scrotum. Then, four folded blue towels, three us.”5 After the patient was positioned, the electro-surgical folded toward the surgical technologist and one folded unit dispersive pad was placed underneath the patient’s left away, were handed to the surgeon one by one and placed lower buttocks.11 around the patient’s surgical site or the pubic area. Once

OCTOBER 2011 | The Surgical Technologist | 451 The suction tube and electrosurgical pen- cil cord were secured to the drape using nonperforating towel clip from the instru- ment set. One basin set was needed and another sterile basin was opened onto a single ring stand to be used as a bird bath. It was filled with alcohol that was used for the surgical team to dip their hands into. Two bulb syringes were needed for irriga- tion, and lubricant was used for the Hegar dilators. Other supplies used included pop-up light handles, a needle magnet and a needle counter, gloves for all of the sterile team members, sterile marking pen and labels for labeling the medications used during the procedure, a 10 cc syringe with a 22-gauge needle for the injection of the local anesthetic and a Foley catheter with a drainage unit.10 A semi-rigid penile implant was also requested by the surgeon since the inflatable implant malfunctioned in the patient. The type of implant used was the AMS Spectra Concealable Penile Prosthesis.

Ambicor Penile Prosthesis INSTRUMENTS AND EQUIPMENT COURTESY OF AMERICAN MEDICAL SYSTEMS A sequential compression device with disposable leg wraps was applied to the patient’s legs in order to prevent emboli the four blue towels were placed by the surgeon, the surgical and thrombi. The suction tube was hooked up to a suction technologist grabbed and passed the drape. A laparotomy unit. The last piece of equipment included the electro-sur- drape was placed on the surgical site; the bottom of the gical unit. drape was extended over the patient’s lower extremities and A minor instruments tray was necessary for basic instru- then the top of the drape was extended toward the patient’s ments used during the procedure. A penile instrument set head. The anesthesiologist secured both sides of the drape was also necessary. Heagar dilators were needed to dilate to the IV poles. the corpus cavernosum of the penis. The 11/12, 13/14 and 15/16 dilators were used during the procedure. The Lonestar SUPPLIES Retractor with Dura Hooks was requested by the surgeon for A small plastic blue drape was needed for the Mayo stand the retraction of the skin flaps. A caliper was needed to mea- with the implant. A #15 knife blade was needed for the inci- sure the diameter and the length of the corpus cavernosum sion and a #10 blade was needed to cut the previous penile on both sides of the penis. This was necessary to request the implant. The suture was organized on the back table. The correct size implant. Mayo clamps were used to load the Dura suture included: 2-0 Vicryl CT-2 (X3), 3-0 Vicryl SH (X3) Hooks and to stabilize the Foley Catheter after it was inserted and a 4-0 Vicryl PS-1. The suction tubing and the electro- into the penis. Other instruments used during the procedure surgical pencil were brought up to the sterile field by the included a #3 knife handle, Debakey forceps, Weitlander surgical technologist and then the surgeon threw the cord Retractor, straight Mayo scissors, curved Mayo scissors, Allis and tube off to the circulator so they could be plugged in. Clamps, Babcock clamps and Mayo-Heagar needle holders.

452 | The Surgical Technologist | OCTOBER 2011 MEDICATIONS A 3% hydrogen peroxide solution was used for irrigation. A penile prosthesis is usually the last Normal saline or sodium chloride (1000 cc) was used for irrigation as well. 50,000 units of polypeptide antibiotic option for men that suffer from erec- and 1 gram of kanamycin were mixed with the normal saline and used as irrigation. A bupivacaine hydrochloride tile dysfunction. There are other, safer (0.25%) with epinephrine (50 mL) was used for the local options that a man can do before having anesthetic. Th e anesthesiologist gave the patient gentamycin and cefazolin through the IV.11 surgery.

PROCEDURAL STEPS Aft er the patient was brought into the room and prepped gical pencil and the corpora cavernosa was exposed. and draped, the surgical technologist brought up the fi rst Aft er the Weitlander Retractor was removed, the sur- Mayo stand and adjusted it over the patient’s legs. Th en the geon placed the Lonestar Retractor around the wound. Th e back table was brought up to the sterile fi eld and the second Dura Hooks were loaded and passed to the surgeon on Mayo stand was placed by the side of the back table. Th e Mayo clamps and the surgeon carefully placed eight hooks suction tube and electrosurgical pencil cord were secured to for retraction. the drape with a nonperforating towel clip and the holster Aft er the retractor was placed, the previous implant was for the electrosurgical pencil was secured to the Mayo stand identifi ed. eTh surgeon cut the right side of the infl atable with the scratcher attached to it. Th e sterile basin fi lled with prosthesis and removed it. Th e surgeon placed a 2-0 Vicryl 70% isopropyl alcohol was brought up to the fi eld and all of CT-2 dyed suture on the right side. Th is suture was placed the team members dipped their hands in the alcohol. Th e as a stay suture. Th e straight Mayo scissors were used to cut surgical technologist provided the Foley catheter with lube the suture. Th e dilators were soaked in the warm saline with on the tip for easy insertion. Th e catheter was secured to the a polypeptide antibiotic and then dipped in a lubricant. Th e drape with a Mayo clamp because it needed to stay sterile surgeon removed the other side of the implant (left side) throughout the entire case so the surgeon can easily identify and once both sides of the prosthesis were removed, it was the urethra. placed in the kidney basin and passed off to the product Aft er the Foley was secured, the surgical technologist rep. Th e surgical technologist provided the 3-0 Vicryl SH provided the 10cc syringe for the injection of the local anes- un-dyed suture on a needle holder so the surgeon could thetic. Bupivacaine hydrochloride (0.25%) with epinephrine place the stay suture on the left side. Aft er the stay sutures was used for the local anesthetic. As the surgeon injected were placed, the surgeon irrigated the wound to prevent the anesthetic at the base of the penis, the surgical tech- infection. Th e surgical technologist had two basins for two nologist verbalized to the circulator the amount of local diff erent medications; one basin contained 3% hydrogen anesthetic used and then placed two laparotomy sponges peroxide solution and the other contained polypeptide anti- on the fi eld. Th e syringe with the needle on it was prepared biotic mixed with saline. Th ese were used for irrigation. Th e and it was placed next to the sharps box on the back table. surgeon then irrigated the corpora cavernosa and alternated Th en the surgical technologist provided the #15 knife blade between both irrigates. and the surgeon made an incision at the base of the penis Th e surgeon started with an 11/12 Heagar dilator and on the dorsal side that was approximately four centimeters then used a 13/14 dilator to obtain an accurate measure- in length. Th e surgeon cut through the subcutaneous tis- ment of the corpora cavernosa. When the corpora caver- sue and the connective tissue of the penis using the elec- nosa was dilated, the surgeon took the distal and proximal trosurgical pencil and smooth tissue forceps. Hemostasis measurements. Th e measurements were added and the cor- was achieved with laparotomy sponges. Th e thin layers of rect size semi-rigid prosthesis was obtained by the rep. Th e subcutaneous and connective tissue were dissected and the surgical technologist provided the surgeon with the antibi- Weitlander Retractor was positioned for better visualization otic and he applied the antibiotic with a bulb syringe. so the surgeon could identify the structures of the penis. Before the surgeon began to place the new implant in Th e tunica albuginea was then dissected with the electrosur- the patient, he had the sterile team dip their hands in the

OCTOBER 2011 | The Surgical Technologist | 453 basin with alcohol. The irrigation basin was used to sterilize tion, malfunctioning implant and injury to nearby struc- both sides of the prosthesis before insertion. The Lonestar tures such as the urethra, blood vessels, testicles and nerves Retractor and the Dura Hooks were removed and the surgi- of the penis. Infection is a major complication that must cal technologist loaded a 2-0 Vicryl CT-2 suture on a nee- be considered during this procedure. A surgical site infec- dle holder and passed it to the surgeon with smooth tissue tion occurs in about five percent of patients who undergo a forceps. This suture was the dyed suture and it was placed penile implant surgery for the first time. However, the risk on the same side as the other dyed suture (right side). The almost doubles if the patient is replacing a previous implant. surgical technologist provided the first assistant with the This may require the patient to go through another surgery straight Mayo scissors. Then the surgeon performed the to fix the problem if antibiotics do not clear the infection.8 same actions on the left side. The skin was closed with 4-0 Newer models have fewer problems, but a penile implant Vicryl PS-1 suture and the surgical technologist initiated can malfunction over time. According to statistics, “85% or the final count. more are working well 5 years after implantation and 67% Adhesive strips were cut in half for placement on the are working at 10 years.”8 wound. Dressings were then placed over the adhesive strips. The surgical technologist placed the bandage rolls over the POSTOPERATIVE CARE dressings and then taped them to the patient with two-inch The patient was transported from the operating table to the paper tape. These materials were used for penile support. gurney and was transported to the PACU. A jock-strap and gauze dressing was in place when the patient arrived in the POSTOPERATIVE CLEANUP PACU. The anesthesiologist then assessed the patient based The drape was removed in order to wipe off the patient. A wet on the Aldrete scale. The patient was assessed right away sponge cleaned up the prep and blood and another sponge and every fifteen minutes afterward for a total of one hour.12 dried off the patient. The surgical technologist began the The patient’s pain was controlled with oral medications cleanup process while the anesthesiologist woke the patient. and needed oxygen immediately after surgery to maintain All instruments were gathered and placed in the case cart for a level of 90% oxygen saturation. Fifteen minutes after sur- sterilization. By the time the surgical technologist was fin- gery his oxygen saturation was at 97%. The patient’s vital ished gathering the instruments, the patient was ready to be signs were then compared with his preoperative values. His transferred to the gurney. The surgical technologist was in blood pressure and his pulse rate were both within 20% of charge of moving the feet of the patient. Once the patient was his preoperative values. His blood pressure was 97/71 and transferred, the surgical tech finished the cleanup. his pulse rate was 88 beats per minute.12 The patient was ready to be released after one hour. His SPECIAL CONSIDERATIONS dressings remained clean and dry and the patient was dis- The patient was not obese or a diabetic. A sequential com- charged to his wife. pression device was placed under the operating table and disposable leg wraps were placed on the patient’s legs to pre- OTHER OPTIONS BESIDES SURGERY vent embolus formation and thrombus formation. A penile prosthesis is usually the last option for men that Another consideration is that there was an implant suffer from erectile dysfunction. There are other, safer placed in the patient. The circulator recorded these all of options that a man can do before having surgery. Medica- these descriptions in the patient chart. The chart read, tions can be taken orally by the patient. These medications “Procedure Implants, OR description: AMS Spectra Con- raise the amount of nitric oxide in the body which produces cealable Penile Prosthesis, diameter 14 mm, length 20 mm, an erection. However, they do cause certain side-effects and total quantity: 1, Lot number: 637210005, catalog number: a physician will decide what medications, if any, the patient 720056, and site implanted: penis.”11 can take to help with erectile dysfunction. Low hormone levels also may have an effect on the ability to produce an COMPLICATIONS erection. In this case, the physician may put the patient on In this case, the patient had no intraoperative or postop- the hormone testosterone. Penis pumps are also an option erative complications while he was at the hospital. Possible for the male patient. The pump works like a vacuum to complications can include hemorrhaging, surgical site infec- bring blood through the corpora cavernosa, which creates

454 | The Surgical Technologist | OCTOBER 2011 an erection. Aft er the erection occurs, a ring is placed at the base of the penis in order for the man to keep his erection.7 WRITE FOR US! ABOUT THE AUTHOR Debbie Gutierrez, cst, Do you get giddy about a certain procedure? Or have a studied at San Joaquin specialty that gets your heart pumpin’? Valley College in Fresno, Then write a CE article for AST’s the outline is returned to you California. The Surgical Technologist and share for approval, begin writing your your passion with your peers. manuscript. Getting your outline Share the latest advances and approved will save you time REFERENCES techniques about the procedures and effort of writing a manu- 1. Brosman, S A. Erectile Dysfunction. 2009 Accessed July you really care about and love. script that may be rejected. 27, 2010. http://emedicine.medscape.com/article/444220- We are always looking for CE UÊ-ÕL“ˆÌʓ>˜ÕÃVÀˆ«Ì]Ê>ÃÊÜiÊ overview authors and surgical procedures as any art to illustrate your 2. Cohan, R H. Radiology of Penile Prosthesis. 1989. 925- authored topic. You will be 931. Accessed July 27, 2010. http://www.ajronline.org/cgi/ that haven’t been written about notifi ed upon receipt of receiv- reprint/152/5/925.pdf or the latest advancements on a 3. Cohen, B J. The Male and Female Reproductive Systems. commonplace surgery. You don’t ing the manuscript and as well The Human Body in Health and Disease 2009. 489-490 have to be a writer to contribute as any changes, additions or Philadelphia: Wolter Kluwer Lippincott Williams and concerns. Wilkins. to the Journal. We’ll help you 4. Goldman, M A. Genitourinary Surgery. In Pocket Guide to every step of the way, AND you’ll Things to Remember the Operating Room 2008. 365-368. Philadelphia: F A Davis earn CE credits by writing a CE UÊi˜}Ì \Ê œ˜Ìˆ˜Õˆ˜}Êi`ÕV>̈œ˜Ê Company. article that gets published! 5. Junge, T, Ross, T. Genitourinary Surgery. In Frey, KB articles should run a minimum and Ross, T. (Eds), Surgical Technology for the Surgical Here are some guidelines to kick of 2,000 words and a maximum Technologist. 2008. 774-776. Australia: Delmar Cengage start your way on becoming an of 5,000 words. Learning. author: UÊ,iviÀi˜ViÃ\Ê ÛiÀÞÊ>À̈ViÊ 6. Mayo Clinic Staff. Erectile Dysfunction. 2010. Accessed July 28, 2010. http://www.mayoclinic.com/health/erectile- 1. An article submitted for a CE Vœ˜VÕ`iÃÊÜˆÌ Ê>ʏˆÃÌʜvÊ
Ê dysfunction/DS00162/DSECTION=treatments-and-drugs must have a unique these or references cited in the text. All 7. Mayo Clinic Staff. Penile Implant. 2009. Accessed July 26, angle and be relevant to the articles that include facts, his- 2010. http://www.mayoclinic.com/health/penile-implants/ surgical technology profession. tory, anatomy or other specifi c MY00358/DSECTION=risks or scientifi c information must 8. Monterey Bay Urology Associates. Penile Implant 2. The article must have a clear cite sources. (Prosthesis) Surgery. 2007. Accessed July 26, 2010. message and be accurate, thor- http://www.montereybayurology.com/urocond/ ough and concise. UÊ œ«ÞÀˆ} Ì\Ê7 i˜Êˆ˜Ê`œÕLÌÊ>LœÕÌÊ PenileImplantSurgery.htm 3. It must be in a format that copyright, ask the AST Editor 9. Nagle, G M. Genitourinary Surgery. In Rothrock, JC, maintains the Journal’s integ- for clarifi cation. Alexander’s care of the patient in surgery. 2007. 490-493. UÊ
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Ê Pennsylvania: Mosby Elsevier. rity of style. articles submitted for pub- 10. Robert, J. Insertion Malleable Penile Prosthesis in Surgery 4. It must be an original topic (one Preference Card. 2010. Unpublished surgical preference care, that hasn’t been published in lication should be free from St. Agnes Medical Center, California. the Journal recently.) plagiarism, should properly 11. St. Agnes Medical Center. Patient chart. 2010. Unpublished document sources and should Patient Chart, patient name excluded due to HIPPA How to Get Started have attained written docu- regulations. 12. UK Health Care. Erectile Dysfunction may be a Sign of The process for writing a CE can mentation of copyright release Cardiovascular Disease. 2007. Accessed July 28, 2010. http:// be painless. We are here to assist when necessary. AST may ukhealthcare.uky.edu/publications/AI/cardio/ed_heart.asp you every step of the way and refuse to publish material that 13. Web MD. Erectile Dysfunction: Penile Prosthesis. 2010. make sure that you are proud of they believe is unauthorized Accessed July 27, 2010. http://www.webmd.com/erectile- use of copyrighted material or dysfunction/guide/penile-prosthesis your article. a manuscript without complete 14. Web MD. Erectile Dysfunction (Impotence) and Diabetes. UÊ7ÀˆÌiÊ̜ʫÕLˆV>̈œ˜ÃJ>ÃÌ°œÀ}]Ê 2007. Accessed July 27, 2010.http://www.webmd.com/erec- documentation. tile-dysfunction/guide/penile-prosthesis and state your interest in writ- ing, and what topic you would Don’t delay! Become an author like to author. today. Write to us at publica- UÊ-ÕL“ˆÌÊ>˜ÊœÕ̏ˆ˜iʜvÊޜÕÀÊ«Àœ‡ [email protected] posed topic for review. Once

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